7 EDI Rule 69L-56 F.A.C.This EDI Implementation applies to all required form filings for all Dates of Injuries, and not just those injuries that occur after the Insurer’s EDI Implementation date. This includes legacy claims.

9 On a National level, in 1990 the IAIABC spearheaded a program to utilize the concept of EDI for Workers’ Compensation data.

10 What is the IAIABC?The International Association of Industrial Accident Boards and Commissions.A 93-year-old organization of jurisdictional workers’ compensation administrators and others interested in WC.

11 What is EDI?Electronic Data Interchange is the electronic exchange of data between business trading partners (i.e., claim administrators to state agencies), in a standardized format.This does not include reporting byInjured Workers!EDI

12 Bringing Together the Important ParticipantsDeveloping an Electronic StandardBringing Together the Important ParticipantsJurisdictionsCarriersVendorsTPA’s

13 Developing a National Standard through the IAIABC EDI Development Committees was a “consensus development” process that required “give” and “take” from all participants.

14 The end result is a national standard format for the reporting of workers’ compensation data electronically.

25 GlossaryThe purpose of the Glossary is to acquaint the reader with easy-to-understand definitions of workers' compensation terms that are not defined in the R3 Dictionary as Data Elements.

26 GlossaryThe Glossary defines terms that are common to FROI/SROI, MED, and POC EDI reporting.Not all of the terms are directly related to one of the IAIABC EDI reporting products, but they are commonly used in the business and data reporting environment.

30 ACRONYMSEDI Committee participants frequently use acronyms in their discussions, and newcomers (and veterans, too!) can easily lose their place in what is going on if they don’t understand what the acronyms stand for.

36 Release 3 Data DictionaryIdentifies the Data Number (DN)Gives the Definition of the Data ElementGives the Last Revision Date of the Data Element

37 Release 3 Data DictionaryGives the Format (i.e. 2 A/N = two characters alpha/numeric)Lists the Valid Values for the DNGives DP (Data Population) Rule to Help Identify the Correct Use of the Data Element

52 Release 3 FROI TransactionOriginally, the EDI First Report of Injury Record was identified by a Transaction Set ID of '148' and had a specific Record Layout.In Release 3, the 148 record must be paired with a companion record - R21, FROI Companion Record to complete the First Report of Injury transaction.

61 …how many segments must be sent to report the entire Accident Description Narrative?

62 ANSWER = d (4 segments) DN Data Element Name Data Beg End 0038Accident/Injury Description NarrativeAS HELEN WAS LEAVING HER WORK SITE (BLDG 500) SHE16011650WAS WAITING FOR HER HUSBAND TO PICK HER UP ON THE16511700STEPS OF THE BLDG. AS SHE LEANED AGAINST THE RAIL17011750ING & FELL.17511800

65 Release 3 SROI TransactionOriginally, the EDI Subsequent Report of Injury Record was identified by a Transaction Set ID of ‘A49' and had a specific Record Layout.In Release 3, the A49 must be pairedwith a companion record - R22, SROI Companion Record, to complete the SROI transaction.

75 Maintenance Type CodeA code that defines the specific purpose of each transaction being transmitted.

76 Maintenance Type CodeDWC Forms required to be filed with the Division are replaced by EDI filings identified by MTC codes.

77 Maintenance Type CodeMost MTC codes equate to a specific DWC Form that will no longer be required to be filed with DWC. However the DWC Form may still be required to be sent to other parties (e.g., DWC-1, DWC-4).

89 Full Suspensions (of all Indemnity)FL SROI MTC’s:Full Suspensions (of all Indemnity)S7 – Benefits ExhaustedS8 – Jurisdiction ChangeYou should recognize these from the DWC-4 Form

90 Partial Suspension (of a concurrent benefit)FL SROI MTC’s:Partial Suspension (of a concurrent benefit)P7 – Benefits ExhaustedFL’s only concurrent benefit type is PT and PT Supplemental Benefits. If one benefit is suspended but the other benefit continues, a Partial Suspension is filed.

91 Periodic Reports FL SROI MTC’s: SA – Sub AnnualFor EDI R3, the Annual Claim Cost Report has been replaced with a Sub Annual report, due every 6 months from the Date of Injury until the claim is closed.

112 69L-56. 330. Electronic Formats for. Reporting the Employee’s 8th69L Electronic Formats for Reporting the Employee’s 8th Day of Disability and the ClaimAdministrator’s Knowledge of 8th Day of Disability (This section will eventually be repealed after all current R1 trading partners implement R3)69L Insurer Responsibilities Where Third Party Services are Utilized

113 The following DWC paper forms currently being filed with the Division will be replaced by electronic transactions:DWC-1 First Report Of Injury or IllnessDWC-12 Notice of DenialDWC-13 Claim Cost ReportDWC-4 Notice of Action/ChangeDWC-49 Aggregate Claims Administration Change Report

114 EDI filing requirements (i. eEDI filing requirements (i.e., when a claim administrator must file these EDI transactions with DWC) are in Rule 69L-56, F.A.C.Paper form copies required to be sent to other parties will still be required per Rule 69L-3, F.A.C.

115 How Will MTC’s and Insurers Be “Phased In” for Implementing EDI R3?

116 EDI Claims R3 ImplementationThe Division has established by rule two implementation schedules for “phasing in” all of the MTC’s required for R3 reporting:The Primary Implementation Schedule includes MTC’s for reporting the electronic equivalent of the DWC-1, 12, 13 & 49 & some DWC-4 data.The Secondary Implementation Schedule includes MTC’s that equate to most DWC-4’s.

117 EDI Claims R3 ImplementationAgain, implementation of EDI R3 applies to all MTC’s required by rule for all Dates of Injuries, not just for dates of injuries occurring after the Insurer’s R3 production implementation date.Legacy claims are included in the mandate.

120 EDI Claims R3 ImplementationIf there are multiple subsidiary insurer entities within an insurer’s corporate structure / organization, the insurer’s compliance date for the Primary Implementation Schedule will be based on the lowest numeric value assigned to any of the subsidiary insurer entities in the group.

121 For Example (Old Reliable Group): Old Reliable Ins Co. = # 145 Old Reliable P&C Co. = # 328Old Reliable of Illinois = # 733All insurers in the Old Reliable Group are required to file electronically in the firstgroup of the Primary ImplementationSchedule. They must begin testingon

122 EDI Claims R3 ImplementationThird Party Administrators (TPAs) are not included in this list because they are not ‘Insurers’.However, a TPA must be ready to comply with the EDI filing requirements as soon as their first Insurer client is required to comply.

123 EDI Claims R3 ImplementationThird Party Administrators (TPAs) are not required to implement all of their insurer clients at the same time, but….

124 EDI Claims R3 Implementation…the 30 day initial late filing penalty waiver in rule 69L (d), is only applicable to the “claim administrator” as a whole at the time it first implements R3 EDI filings.

125 EDI Claims R3 ImplementationTherefore, if a claim administrator implements R3 EDI for different clients at different times, the subsequent clients will not be granted a separate 30 day late filing penalty waiver.

126 Claims EDI Primary Implementation Schedule Phase In:The first group (Insurer Code #s ) begantesting November 1, 2007, and are being phased in to production beginningFirst Group Must Begin Testing:First Group Phased In Production:

127 Claims EDI Primary Implementation Schedule Phase In:The second group (Insurer Code #s ) must begin testing February 1, 2008, and be in production no later than the last day of the3rd month after the testing period begins.Second Group Must Begin Testing:Second Group Must Be In Production:

128 Claims EDI Primary Implementation Schedule Phase In:The third group (Insurer Code #s and ) must begin testing May 1, 2008, and be in production no later than the last day of the 3rd month after the testing period begins.Third Group Must Begin Testing:Third Group Must Be In Production:

129 What ‘Forms’ Will Be Required To Be Electronically Submitted In The Claims EDI Release 3 Primary Implementation Schedule?

139 Claims EDI R3 Secondary Implementation Schedule Phase In:The insurer should begin testing the remainder of DWC-4 related MTC’s no later than 9 months after the its compliance date associated with the Primary Implementation Schedule, and be in production status no later than 1 quarter after the required testing start date.

152 Not all MTC filing. requirements set out in Rule. 69L-56, F. A. CNot all MTC filing requirements set out in Rule 69L-56, F.A.C., can be equated to a DWC Form. See rule and “FL Claims EDI Event Table” (also “MTC Filing Instructions”) for a complete accounting of MTC’s required by FL.

155 The Division will acknowledge every EDI R3 transaction received with the standard EDI Acknowledgement format: ‘AKC’.AKC Report

156 Transmissions received on or before 9:00 p. m. , E. S. TTransmissions received on or before 9:00 p.m., E.S.T., will be processed by DWC the same day the transmission was sent.It will be acknowledged the next calendar day (morning).

157 Transmissions received after 9:00 p. mTransmissions received after 9:00 p.m. EST will be processed by DWC the following calendar day.It will be acknowledged the day after the transmission is processed.

159 The ‘AKC’ acknowledgement will identify how many transactions passed edits (TA -Transaction Accepted); how many failed edits (TR -Transaction Rejected); and the specific error(s) that caused the transaction to reject.

160 FL does not use the TE – “Transaction Accepted with Errors” Acknowledgement Code.

161 If a transaction is improperly rejected by the Division, the entire batch will be re-processed and re-acknowledged using the ‘ARC’ Acknowledgement format (see the technical training PowerPoint for more details on the Acknowledgement Process)

162 The Claim Administrator will receive credit for the date the transaction was originally received by the Division.

164 The on-line Claims EDI Data Warehouse will assist claim administrators in resolving EDI errors faster, and may also assist in resolving issues with the Centralized Performance System (CPS).Claims EDI Warehouse

165 More detailed information regarding the on-line Claims EDI Data Warehouse will be provided later in the training.Claims EDI Warehouse

172 An Event is a business circumstance that occurs in the life of a WC Claim which requires the reporting of EDI information to DWC. These circumstances reflect FL’s requirements, including:First Report of Injury eventsSubsequent Report eventsPeriodic events

173 FL identifies all of the transactions (MTC’s) that are required for reporting specific business events on itsEvent Table.

174 Interpreting the FL Event TableExample: Florida requires the submission of a FROI MTC 00for First Reports of Injury or Illness based on the insurer’s mandate date …

175 Interpreting the FL Event Table… when disability is immediate & continuous & lost time is greater than seven (7) days.

176 Interpreting the FL Event TableThe filing must receive a TA within 21 calendar days after the claim administrator’s knowledge of the injury.

177 Interpreting the FL Event TableA DWC-1 or IA-1 (ACORD 4) form must also be sent to the employee & employer

185 Event Table FL Periodic ReportsSA Sub-Annual – Submitted every 6 months after the DOI, as defined on FL’s Event Table.FN Final – Submitted when Claim Administrator determines no further benefits will be paid.

186 Event TableIn addition to the Event Table, FL describes its business events in the ‘MTC Filing Instructions’. This document assists claim administrators understand what MTC’s to use in reporting required business events to FL.MTCFilingInstructions

193 FL SCENARIO ASSUMPTIONSGeneral scenario assumptions are included in the scenarios to assist in understanding the sample data that is presented.

194 FL SCENARIO ASSUMPTIONSThe FL Scenarios were enhanced from the IAIABC scenarios in the R3 Implementation Guide.All the 2001 dates were moved forward to 2007 (the next year where all dates fell on the same day of the week).

195 FL SCENARIO ASSUMPTIONSCalculated Weekly Compensation Amount is the Comp. Rate, and is 66 2/3% of the Average Wage.The statutory comp rate max is not accurate per FL law.

196 FL SCENARIO ASSUMPTIONSScenarios are presented in uppercase text. However, data may be sent to FL in mixed case format.Payment of indemnity benefits is based upon a 5 day work weekThe Industry Code must be a 2002 or 2007 NAICS code.

198 FL SCENARIO ASSUMPTIONSAdditional data elements may be present in the scenario if they are identified as “IA” (If Applicable/Available) on the Element Requirement Table (e.g., Middle Initial and Suffix).

199 FL SCENARIO ASSUMPTIONSAlthough Claim Administrators may send additional data elements marked “NA” (Not Applicable), such data will not be edited or loaded by FL, and therefore not presented in the scenarios.

206 FL SCENARIOSA FROI must be paired with the applicable SROI that is reporting the initial payment or equivalent, unless the FROI is reporting a Full Denial (MTC 04), Cancel (MTC 01), Change (MTC 02) or Acquired Claim (MTC AQ).

210 Indemnity Benefits other than TP or IB or settlement will be paid, anNEW CLAIM: Lost Time CaseWhere Disability is Immediate and ContinuousIf the Initial Payment of Indemnity Benefits will be made by the Claim Administrator, andIndemnity Benefits other than TP or IB or settlement will be paid, anElectronic First Report of Injury or Illness is due.

211 Due: 21 Days after Claim Administrator’s Knowledge of the InjuryNEW CLAIM: Lost Time CaseWhere Disability is Immediate and ContinuousSend: FROI 00 with SROI IPDue: 21 Days after Claim Administrator’s Knowledge of the InjuryNote: Also provide FORM DWC-1 or IA-1 to the employee & employer.

212 To avoid late filing penalties for an Electronic First Report of Injury or Illness, the EDI DWC-1 should be triggered immediately upon the CA’s disposition of the claim (payment or denial), to allow time for correction of potential errors and resubmission, and for subsequent receipt/acceptance by the Division within the filing due dates specified in Rule 69L-56, F.A.C.

213 FROI “00” Scenario NarrativeEmployee fell from ladder at employer’s warehouse on 6/15/07.Employee broke his leg.Foreman witnessed the accident.Employee treated and released from the Emergency Room.

238 Variable Segment Population Rules for FROIACCIDENT/INJURY DESCRIPTION NARRATIVES SEGMENT:No more than 10 (50 byte narrative text) segments per claim, and the number of segments sent must equal the “Number” of Accident/Injury Description Narratives segment counter.

265 SROI MTC “IP” SCENARIOFL requires the reporting of the exact amount of the Claim Administrator’s initial payment of indemnity benefits on MTC IP; therefore, the Payment segment must also be sent on the SROI, in accordance with the Element Requirement table.